The Journey: Episode Five

MARCH 29, 2020

I haven’t made any progress in losing weight lately. I’m very upset that I had regained all the weight I had lost. I regained about 16lbs from 183lbs. I’ve been eating healthier and exercising more, but I think portion control, my old enemy, is striking me again and again. Food is just so delicious!

My grandma was recently doing an ornish lifestyle program and she shared with me some of the food they had recipes for. I don’t think I could give up meat or animal by-products altogether, but I am contemplating taking red meat out of my diet and putting in more tofu. In fact, tonight my husband is gonna try to make Tofu Long Rice. If I remember to take a picture of it, I’ll post up the recipe. A couple nights ago, he made chicken long rice for us and it was so delicious, but I forgot to take a picture of it.

Whatever my husband and I try to make, I want to share that recipe with you folks so you can make it and eat it too. I’m not sure if you’ll be able to find all of the ingredients though, but I’d like to share them with you anyway.

For exercise, my sisters and I take my dog and my mom’s two dogs walking down at the park. If the weather’s good, we’ll go down, if not, then we just stay inside and I’ll use my sister’s resistance bands just to do something, you know?

Yesterday, we took our dogs down to a little island just off the shore called Coconut Island. With the lockdown/quarantine, the island was pretty much empty except for a homeless man, so we took the dogs off their leashes and let them loose on the island. They had so much fun. My dog had so much things she could sniff and smell. She even chased a couple of birds near the water and ran across the island three times! She’s 15 years old! I even ran with her one of those times. They had so much fun.

We were hoping we could take them again today but it was raining almost all day and there was even some thunder. So today is not a good day to go down, but the next clear day, I’d like to take them back to Coconut Island and let them run free.

Hopefully, this healthier diet and walking the dogs will help me lose some weight. But I also know that I need to watch what I’m eating. I’ve been so hungry lately and I’m not even doing anything! I need to tell my stupid self to stop being so damn dumb and stop eating!

I’m kind of glad I have this Journey blog to keep me accountable and be able to put it out in writing to keep track of my thoughts. If you’re ever thinking that your journey isn’t working, maybe you need to write it down in your own journal, diary, or even a blog. If you decide to make a blog, let me know, I’d love to follow along with your journey as well!


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Metformin in Management

Information

These are what my metformin pills look like at 1000mg.

Metformin is one of the safer, effective and inexpensive drugs used to treat Type 2 diabetes. It is an oral medication that helps to control blood glucose. It comes in multiple forms such as a pill, extended release tablet, and liquid. Usually you’re advised to take it with a meal.

Of course metformin doesn’t work on its own, you have to commit to a lifestyle change. A healthier diet and more exercise will help the user lose weight and lower blood sugar levels. These changes could possibly hold off diabetes in prediabetics for up to 15 years.

Metformin reduces appetite, affects how the body stores fat, and lowers resistance to insulin making your body use your own insulin more efficiently. It can also reduce the risk of dying from heart disease by 30-40%.

Side Effects

Usage of metformin can lead to a vitamin B12 deficiency that could lead to anemia, neuropathy, memory loss, and fatigue.

If you need a CT, MRI, or angiogram that requires the contrast dye you may need to temporarily stop taking your metformin. The contrast dye can cause minor, short term changes to kidney function.

Metformin should not be used if you have severe kidney disease, metabolic acidosis, or diabetic ketoacidosis. Also metformin shouldn’t be used with alcohol.

Pregnancy

During pregnancy, the body can’t create enough insulin to control the blood glucose levels which leads to gestational diabetes. Women with gestational diabetes require insulin injections to help control the blood glucose levels. In women with Type 2 diabetes, that gap grows exponentially with pregnancy. The body is in need of more insulin than can be provided with injections. Studies are being performed to see the long term effects of metformin during pregnancy to see if metformin can be used in tandem with injections during pregnancy to safely keep blood glucose levels in check and see if there are any affects on the baby.


When taking metformin, you’ll see greater results if you also change to have a healthier diet and more active lifestyle. You could potentially hold off full blown diabetes with this medication if you have prediabetes. Watch your health while taking this medication, look out for any side effects and let your doctor know about them as they happen.


Related Content

What is Blood Sugar and A1C?
How to Support Your Diabetic Loved Ones


References

Drugs.com
Diabetes Self-Management, May/June 2019, p. 30-31.


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The Journey: Episode Four

MARCH 21, 2020

Coronavirus has impacted our lives here in Hawaii. Tourists and visitors still come to the islands even though our governor asked people to stop coming. The other counties have put their islands on lockdown, restricted non-essential businesses and placed curfews on their residents and visitors, all counties except Hawaii County. My island hasn’t done anything just yet, which has upset a lot of our residents. Many companies and businesses have shut down and laid off workers, my job included. No need for tour guides when tourists are no longer coming. Plus with my diabetes, I have a compromised immune system and I had to limit my interaction with people anyway.

So I am currently jobless, hopefully after this pandemic, my job will reach out and see if I still want to come back and work for them. We’ll see how I feel about it when that time comes. Until then I have more time to work on my blog and continue working on my health. I’m not sure if I’ll still be able to go down to Liliuokalani Garden to walk our dogs around and get my exercise in. Since I don’t have work anymore I don’t get the same exercise as before. If they have shut down the park then I won’t be able to get much exercise, my neighborhood isn’t completely safe to walk around unfortunately.

We will have to see how things persist, but I will continue to try and do something in the meantime. For now, I am up to 45 units of insulin at bedtime and so far I’ve been pretty consistent around 110mg/dL. I also definitely credit taking my berberine supplement for helping with that. Lately, I’ve been bleeding from the injection site. Last night’s injection produced the most blood. My tummy was warm and I didn’t feel any pain until afterward as usual, but we think I may have knicked a vein or something. But once I wiped the blood away, it stopped bleeding. I suppose as long as it stops, I should be okay.

Right now, my endocrinologist appointment still stands for April 30 on Oahu, but if anything changes with the COVID-19 situation I may have to reschedule but we’ll cross that bridge when we get there. I just need to keep taking my meds and staying as active as I can be.

I’ve been very frustrated with my weight lately. I have gained it all back. I think I should go back on my apple cider vinegar supplement in hopes it’ll help control my appetite. If I go to my appointment on Oahu next month, I’d like to show that I lost weight instead of gained. Especially now that I’m not currently working. I need to exercise more and eat less. I hope I can do it.

How to Check Your Blood Sugar

Regardless of what type of diabetes you have, you need to know how and when to take your blood sugar. It is one of the most important aspects of diabetes management.

Find the Right Meter

First thing first is to find the right glucose meter. I am not familiar with ones used by Type 1 diabetics, but I can definitely help you find one for Type 2. I have used two meters so far, Reli On and True Metrix.

My Reli On was from Walmart. It worked well enough, simple to use and easy to read. I loved the lancer and the lancets I used for it. The lancer looked nice and the lancets came in ultra thin which didn’t hurt my fingers that bad. I loved it. However, in January, I tried to get more glucose strips for my Reli On and my Walmart didn’t have any. For a whole week, they were completely out. I couldn’t wait for a shipment to come in or restock or whatever, so my husband went to CVS pharmacy and bought a True Metrix Air.

When I say I love my True Metrix, I mean it. I HATE the lancet. It’s ugly and the lancets that came with it are definitely not ultra thin. It hurt like a mother when I first pricked myself. I decided to never use that lancer again. So I use my Reli On lancer and the remaining ultra thin lancets with my True Metrix. The best thing about the True Metrix is that it has bluetooth connectivity and comes with an app on my iPhone. I check my blood sugar open my app and it logs the reading. It gives me an average of all my readings, let’s me know when my blood sugar is in range (it hasn’t been yet), and I can take notes about the dosage and which side I inject on my tummy.

My Personal Glucose Meter

I love my meter. Super convenient to keep track of my readings with the bluetooth function. I think I want to name her Trixie.

The True Metrix isn’t super cheap or expensive. It was around $20. I haven’t gotten a prescription to get one, but I think you might be able to get one. I don’t know how that works, bring it up with your doctor. Maybe you could get a prescription on the glucose strips too.

When you go to choose your meter, price is definitely one of the things to look for. I feel like anything over $25 is ridiculous. It better be able to make me some morning coffee for $25+.

My second requirement is aesthetics. If I have to look at this thing every day, I’d like it to look nice. True Metrix definitely fits that bill. The meter, the lancer, the lancets, and strips should look nice to me.

My last requirement is ultra thin lancets. Anything thicker and it hurts, no matter how warm my finger is before I prick it, it always hurts. The less painful it is, the better.

When to Check

Some of the best times to check your blood sugar are:

  • Mornings, before breakfast
  • 1-2 hours after a meal
  • Before, during, and after exercise – just to make sure your blood sugar doesn’t dip too low
  • Bedtime
  • Whenever you feel the symptoms of hypoglycemia or hyperglycemia.

*** Also don’t forget: DO NOT reuse your lancets for more than one reading. If you didn’t draw enough blood the first time, I see no sense in using a new lancet for a second draw, but discard the lancet after you test your blood.***

Testing Your Blood Glucose

Before you use your glucose meter for the first time, you need to calibrate it. You should by calibrating solution for your meter and follow the directions in your device’s instruction manual.

After that is done, prepare your lancer and get a test strip from your bottle. Close the bottle immediately after removing a test strip and use the bottle within 30 days.

Before lancing, wash your hands with soap and warm water. The warm water will help to get your blood circulating so it will be easier to draw blood the first prick without having to lance again and use another test strip.

When choosing the spot to lance and draw blood, obviously choose your non-dominant hand. This poor hand is going to get poked and pricked a lot in the foreseeable future. Personally, I only use my middle, ring, and pinky fingers on my left hand, because I tend to not use those fingers as much as my index and thumb and it stings a little after lancing.

I suggest choosing a site on the sides of your fingers, avoid the pads and tips since they are the most sensitive.

Possible Lancing Sites

Choose the sides of your fingers (within the black circles) and avoid the pads and tips (the red areas).

Also be sure to remove any rings before lancing to maximize the blood flow in that finger.

Prepare yourself for the prick. Once you have lanced yourself, massage the palm directly below the finger and massage upwards so a droplet of blood comes from the site. Once there’s enough blood for the sample, put your test strip into your meter.

When the meter turns on, take the strip and put it up to the blood droplet. You don’t want too much that an error shows on your meter, but you don’t want too little either or an error message will show. If an error does occur, you need to get out a new test strip. Hopefully, you will be able to massage more blood from the original site. If not, you will have to lance again. Because my needles are ultra thin, it’s really hard to draw enough blood for a sample and if I don’t get it the first time, then I have to move to another site because it’ll be impossible to massage more blood from the same spot.

Discarding the Waste

Once the blood sample is in the strip it will take a few moments before the result pops up on the screen. Log that number down and what time it was that you took the reading. Once you’re done, remove the strip from the meter and discard it and the lancet you just used. Use a tissue to clean your finger of the blood. Once everything is put away, go ahead and wash your hands. Please don’t touch your face after drawing blood, you could have blood-borne pathogens and that would suck.

I use an empty laundry detergent container for my used needles and test strips. The plastic is hard enough that the needles won’t puncture and I don’t have to use one of those biowaste containers from the pharmacy. Whatever container you choose to use, make sure it’s made of durable plastic so the needles don’t puncture.

Congratulations, you just took your blood glucose reading. For a step-by-step visual process, feel free to check out YouTube. I like this video from Mayo Clinic. It’s a bit old but meters still work the same way. Maybe one day I’ll make my own video and post it on my YouTube channel but for now go ahead and find any one.


Related Content

What is Blood Sugar and A1C?
Some Signs You Might Have Diabetes


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The Journey: Episode Three

MARCH 12, 2020

So far I think I have figured out my insulin and subsequent blood glucose reading. Since my insulin is once daily at bedtime, I check my blood sugar as soon as I wake up in the morning. Which is a bit of a challenge because sometimes I will take it anywhere from 6:30 to 9:30am. Not very consistent. BUT I have figured out that if I take my berberine supplement the night before, it helps to lower my blood sugar. I can also take berberine during the day time but I don’t usually check my sugar for the rest of the day unless I have an unusual episode of hypoglycemia.

Last week Saturday to Monday, my blood sugar was great. It was well within the parameters my doctor said I should aim for (75-125 mg/dL). During those days I had heavier lunches and lighter dinners PLUS my berberine. I stopped eating after 7pm as well. On Tuesday, I did the same diet plus berberine BUT no insulin, that resulted in a higher reading. So boom that’s how I can do it: heavy lunches + light dinners + berberine + insulin = good glucose reading.

But then Friday was a bad day for me. I was eating all over the place. I still kept to the no food after 7pm. However, I had decidedly eaten fast food and other unhealthy bits. When I woke up my sugar was 154. Yikes! I was taking 40units of insulin at the time, my 10th dose. After one more dose of 40units I decided I should go up to 45units.

Unfortunately, I still haven’t been able to get my sugar back down, so I have to go back to the reliable heavy lunch, light dinner, berberine and insulin combo and see what happens. AND I have to stay away from fast foods, soda, and other sweets.

I also managed to gain weight again. I’m super upset about that. I’m back to 200lbs and very very upset. I am trying to do whatever I can to get off my butt and moving around the house when I’m not at work. Yesterday I took my dog to the park while my husband was at work and we walked around for 2 hours. It would have probably helped but I made bad food decisions afterwards. I had an ice cream cone… I wanted to get a healthier option but the ice cream shop was closed, I suspect because of the coronavirus. It was so hot yesterday and I really wanted that ice cream. Many regrets.

My husband and I want to start trying for a family one day and I found out that if your A1C is over 9% your baby can be born with a birth defect. For a diabetic, it’s best to get your A1C down to 6.5% before you begin trying. That’s a long way for me, but I really want to get there. I already have the names of our children if we ever get there. This is my dream and I have to fight for it.


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One of the last pictures I have of my dad, when I graduated from high school in 2012. Also one of our last family photos before he passed away.

Featured Story #1: Courtney D.

My dad was my hero. I always thought there was nothing that could happen to him. He was the strongest man I knew. He had type 2 diabetes since he was 18 years old. From some old pictures, he was overweight since he was a child. I never knew what diabetes was and that is one of my biggest regrets. Sometimes, I think that maybe if my family and I really understood diabetes and what you could do to manage it, maybe he would still be here today.

He was 43 when he passed away in 2014. We never really found out what had happened that day. He had so many health problems that any one of them could have been what did it. There were so many different factors that could have been the tipping point, but we could have done so many things that could have changed that.

I was diagnosed with type 2 diabetes in 2016. In 2018, I took a diabetes management class for a couple weeks that helped me learn more about the disease. I wish I had known all that stuff when dad needed it the most. Diet and exercise is the key. However, my dad’s diet was difficult. He had diabetes, heart problems, and he was on dialysis. Some of the foods on the dialysis diet weren’t good for diabetes and vice versa.

Either way, he could have used more exercise. All we had to do was go outside for a walk with him and we didn’t do that often enough. I wish we had. I wish we had done more. But there’s no way we can go back, there is only learning from the past so we don’t make the same mistake in the future. All I can do is do for myself what I couldn’t for my dad.

How Exercise and Diabetes are Connected

Exercise is very important for those who have diabetes. By being active, you can reduce long-term health risks, improve insulin sensitivity, and enhance mood and overall quality of life. Most of the time, working out causes blood glucose to drop, but some exercises can cause glucose levels to rise.

Using your muscles helps burn glucose and improves the way insulin works. Some workouts like weight lifting, sprints, and competitive sports can release stress hormones like adrenaline. Those hormones can stimulate the liver to release glucose.

The food you eat before or during workout can also contribute to your glucose levels. If you eat too many carbs before exercising could cause your glucose levels to stay high regardless of exercise.

Here are some exercise tips:

  1. Choose moderate-intensity aerobic workouts or circuit weight training with light weights and high reps.
  2. Practice relaxation techniques like meditation before and during exercise to minimize adrenaline effect.
  3. Consider doing your workout later in the day than in the morning. Some people experience high levels of glucose in the morning naturally.
  4. If you are taking rapid-acting insulin or short-acting diabetes medications, consult your doctor about adjusting it prior to working out if they produce a glucose rise.
  5. Avoid consuming excessive amounts of carbs before and during exercise. Try some yogurt with nuts or peanut butter.

Keeping a workout log and checking your glucose before, during, and after each workout you try can help you see which exercise works best for you and what pre-workout foods affect your glucose.

If I had known what I know now back in 2010, I wonder if I could have helped my dad and support him in his diabetes. I never knew about diet and exercise when you had diabetes. I thought it was just take your meds and avoid sugar. It’s not that simple and it’s so difficult to do it alone.

I will release another post about which exercises would work best for diabetics and bonus, they can be done with others. You don’t have to go it alone.


References

Diabetes Forecast July/August 2019, p. 12

How to Support Your Diabetic Loved Ones

There are many ways you can support your loved ones, it depends on the situations that surround your relationship. This is a general guide full of suggestions that can help you support the loved ones in your life who, just like me, are diagnosed with Type 2 diabetes. I have no experience with supporting someone with Type 1 and I wish you the best of luck with your journey, hopefully these suggestions can help guide you in the right direction.


What is Type 2 diabetes?

Type 2 is when the body cannot use insulin the way it should, also known as insulin resistance. The food we eat is broken down in to glucose which the body uses as fuel. The pancreas releases insulin to help get the glucose from your blood to the other cells in the body. When the body continues in-taking sugar, the pancreas creates excess insulin and eventually the body cannot keep up with production and that function becomes impaired and sugar begins building up in the bloodstream.

How do you manage it?

A photo of my sisters and I at my wedding having fun. We have fun when we're together and I love them.
My sisters and I at my wedding, laughing and having fun. We always have fun together, I don’t know what I would do without them.

Type 2 is managed using insulin, oral medications, and glucose monitors. Monitors are used at various times of the day to measure our blood sugar levels and can tell us if we are experiencing low-, high- or normal blood sugar levels. We use lancets to prick our finger to draw a drop of blood. We put a test strip in to our monitor and put it up to the drop of blood, hopefully it is enough of a sample, and the device reads it. For treatment, we take oral medications, mostly metformin. If we need an extra boost, we have a dose of insulin, which can be taken with every meal, at bedtime, or once a week.

What can I do to help in cases of emergency?

If we are having an emergency, it will most likely be the result of a low blood sugar episode. This could look like cold sweats, disorientation, fatigue, and light-headedness. This can be remedied with fast-acting glucose such as juice boxes, hard candy, glucose tablets, or any other sugary food or drink. On the extreme, we might have passed out and become unconscious. If this happens, call emergency services immediately. Hopefully we will have set up our Medical ID that can help emergency personnel treat us properly.

What can you eat?

Type 2 diabetics can eat whatever they choose to eat, as long as they mind the glycemic index (sugar content) or the amount of carbs in the foods they eat and the amount of insulin they need to inject after consuming food. Sugary foods and carbs are okay in MODERATION.


Beware of sugar-free, low-carb, etc labels. Just because it says sugar-free does not mean they are not filled with other alternatives. Most of the time when they say it is free of or low in something, companies have had to add something else to make it taste nearly the same to keep people coming back for more.


Most doctors will tell their patients that were recently diagnosed that they need to make a lifestyle change in order to control their blood sugar. My biggest advice for you is to support our new lifestyle. We may need to go out and exercise more, why not go on that walk around the neighborhood with us? We may need to cut out excess desserts from our diet, why not avoid eating sugary foods in front of us?

Please avoid micromanaging us, we know what we can and cannot eat. Please avoid chastising us, we know we shouldn’t eat that slice of pizza, just let us and make sure we don’t eat too much of it.

You do not need to tiptoe around us, just keep in mind that these changes could be drastically different from the lifestyle we lived before and it may be hard for us to change everything in our life in the beginning. Help make it easier for us, do it with us. Who knows, maybe that walk might help you keep diabetes away from yourself.


Related Content

What is Diabetes?
Some Signs You Might Have Diabetes


References

Beyond Type 2 Blog